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Is it acute or chronic? Acute onset of a cough would suggest an acute URI, viral pneumonia, or bronchopneumonia. A chronic cough is more suggestive of pneumoconiosis, chronic bronchitis, emphysema, bronchiectasis, tuberculosis, carcinoma of the ... DIAGNOSTIC WORKUP
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Are there exudates? This is a key question when evaluating a sore throat. Most cases of sore throat with exudates will be found to have streptococcal pharyngitis. Without exudates, one could still have a ... DIAGNOSTIC WORKUP
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Is there a history of drug ingestion or injection? This will help diagnose drug reactions and serum sickness, which are common and easily discovered in the history. Patients with glucose-6-phosphate dehydrogenase deficiency may ... DIAGNOSTIC WORKUP
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Is there a history of drug ingestion or injection? Of course, the history should reveal that the patient has been on a certain drug or has received certain antitoxins, serums, or vaccines.
Is there a rash? If there is a ... DIAGNOSTIC WORKUP
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Fever is defined as an elevation of normal body temperature (37°C, or 98.6°F). True fever occurs when the body adopts a new thermoregulatory “set point” secondary to the release of pyrogenic cytokines in response to bacteria, viruses, or other exogenous... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Sore throat is a common symptom. Many patients incorrectly believe that antibiotics improve the clinical course in all sore throats. Although the vast majority of sore throats are of viral origin and should be managed conservatively, an appropriate history and physical exam... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Initial history of cough should include an assessment of the production of sputum, and the quantity, quality, and circumstances of the sputum production and coughing episodes. Additionally, associated history and physical findings, with particular attention to inciting factors such as... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Initial history of cough should include an assessment of the production of sputum. Additionally, associated history and physical findings, with particular attention to the quantity, quality, and circumstances surrounding coughing episodes and social... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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The etiologies of rash with fever are vast, but a systematic approach will help the clinician quickly narrow the differential. Patients who appear “toxic” with fever and prostration must be rapidly and thoroughly evaluated to rule out life-threatening infections and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Most sore throats and coughs are due to infection. Children may have 5–8 upper respiratory infections per year. The primary differential is between viral and bacterial etiologies, especially group A β-hemolytic streptococcus.
... Workup and Diagnosis ... Treatment
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Cyclic or periodic fever is an unexplained fever that recurs after fever-free periods at almost predictably fixed intervals. True cyclic fever is rather uncommon in childhood; it should be differentiated from recurrent fever, which refers to fever... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Recurrent or relapsing fever is a cluster of febrile episodes that occur over a period of time, with documented fever-free intervals and without an apparent medical cause for each episode. It should be differentiated from cyclic fever, which... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Fever of unknown origin (FUO) is a term that is often misused to describe febrile illness without an obvious etiology or without other symptoms. The definition in different studies is arbitrary, but basically refers to at least 2 weeks of daily documented fever that is unexplained... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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A cough occurs by increased intrathoracic pressure against a closed glottis (Valsalva maneuver), followed by the abrupt opening of the glottis and a sudden expulsion of air. Increased intrathoracic pressure leads to dynamic compression of the airways. The effect of air flow at high... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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In adults, “chronic” is often defined as more than 3 months of coughing in 2 years, but chronic cough is not as well defined in children. In general, for children, cough of more than 3–4 weeks’ duration will be brought to the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Fever is an elevation of body temperature over the normal daily range for a specific individual in response to different insults. It occurs when the thermoregulatory center in the hypothalamus is reset to higher temperature because of exogenous and... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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... The differential diagnosis of cough is best developed with the use of anatomy. Cough may arise from an irritative focus anywhere along the respiratory tract. The irritation may be intrinsic, in which case it is usually inflammatory, neoplastic, or toxic, or it
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... The differential diagnosis of fever is best developed using physiology first and anatomy second.
FEVER, NONINFECTIOUS CAUSES
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... Breaking down the orophraynx, nasopharynx, and larynx into anatomic components is not very valuable in developing a differential diagnosis of sore throat. What is useful is to use the mnemonic VINDICATE to establish the etiologies. Further analyzing the differential (because so many
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... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. It's most prevalent in the fall and may recur in the same... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations
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... Productive coughing is the body's mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn't remove. It's a sudden, forceful, noisy expulsion of air from the lungs that contains sputum, blood, or both. The sputum... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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...Pyrexia
A fever is a common sign that can arise from many disorders. Because these disorders can affect virtually any body system, a fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though,... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn't yield sputum or blood. It's one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Acute
Viral upper respiratory infection
Pharyngitis
Rhinitis
Tracheobronchitis
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... 1. Samiy AH, Douglas RG, Barondess JA (eds): Textbook of Diagnostic Medicine. Philadelphia: Lea & Febiger, 1987.
2. Fraser RG, et al. (eds): Diagnosis of Diseases of the Chest, 3/e. Philadelphia: WB Saunders, 1989.
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... Neuromuscular Causes
Ingestion or overdose (e.g., tranquilizers, sedatives, anesthetics, anticholinesterases)
Cerebral, brainstem, or high spinal-cord injury or infarct
Primary neuromuscular disease
Guillain-Barré syndrome
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... Central Causes
Voluntary hyperventilation
Anxiety, pain
Hypoxia
Fever
Salicylate toxicity
Head trauma
Brain tumor
Central nervous system infection
Cerebrovascular accident
Pregnancy
Recovery phase
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... Central Nervous System Disorders
Drug intoxication
Sedatives
Tranquilizers
Analgesics
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... Interstitial Disease of Known Etiology
Inorganic dusts
Silica
Silicates, especially asbestos, talc, kaolin, diatomaceous earth
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... Infection
Bacterial
Bacterial endocarditis
Sinusitis
Osteomyelitis
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... Infections
Bacterial
Streptococcus pneumoniae
Salmonella spp.
Haemophilus influenzae
Staphylococcus aureus
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... In patients with essentially normal lung tissue, acute respiratory failure (ARF) usually means partial pressure of arterial carbon dioxide (PaCO2)above 50 mm Hg and partial pressure of arterial oxygen (PaO2) below 50 mm Hg. These limits, however, don... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Infant respiratory distress syndrome (IRDS), also called hyaline membrane disease, is the most common cause of neonatal mortality. In the United States alone, it kills 40,000 neonates every year. IRDS occurs in premature neonates and, if untreated, is fatal within 72... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Signs and Symptoms Rapid, shallow breathing; dyspnea, crackles, rhonchi; hypoxemia; bilateral infiltrates on chest X-ray
Treatment (Tx) Treatment of underlying disorder, supportive care ... Pictures
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... Signs and Symptoms Shallow or deep respirations (or both), air hunger, cyanosis, adventitious breath sounds, confusion, decreased level of consciousness, tachycardia, pulmonary hypertension, irritability, decreased reflexes ... Treatment (Tx)
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... Signs and Symptoms Confusion, apprehension, asterixis, coma, headache, dyspnea, tachypnea, papilledema, depressed reflexes, tachycardia, hypertension or hypotension, arrhythmias, vasodilation
Treatment (Tx)
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... Signs and Symptoms Deep, rapid breathing; dizziness; agitation; circumoral and peripheral paresthesia; carpopedal spasms; twitching; muscle weakness; seizures; arrhythmias
Treatment (Tx)
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... Respiratory syncytial virus (RSV) infection results from a subgroup of the myxoviruses that resemble paramyxovirus. RSV is the leading cause of lower respiratory tract infections in infants and young children. It's the major cause of pneumonia, tracheobronchitis, and... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... The respiratory system distributes air to the alveoli, where gas exchange — the addition of oxygen (O2) and the removal of carbon dioxide (CO2) from pulmonary capillary blood — takes place. Certain specialized structures... External respiration
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... Signs and Symptoms Productive cough (purulent sputum), pleuritic chest pain, sweating, fever, chills, headache, malaise, weight loss
Treatment (Tx) Antibiotics, oxygen therapy, supportive care (I.V. fluids, aspiration
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... Even though it's largely preventable, lung cancer has long been the most common cause of cancer death in men and is an increasing cause of cancer death in women. Lung cancer usually develops within the wall or epithelium of the bronchial tree. Its most common types are epidermoid ... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Severe acute respiratory syndrome (SARS) is a viral respiratory infection that can progress to pneumonia and, eventually, death. The disease was first recognized in 2003 with outbreaks in China, Canada, Singapore, Taiwan, and Vietnam, with other countries ... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Colorado tick fever is a benign infection caused by the Colorado tick fever arbo-virus and transmitted to humans by a tick. It occurs in the Rocky Mountain region of the United States, mostly in April and May at lower altitudes and in June and July at higher... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Lassa fever is an epidemic hemorrhagic fever caused by the Lassa virus, an extremely virulent arenavirus. This highly fatal disorder kills 10% to 50% of its victims, but those who survive its early stages usually recover and acquire immunity to secondary attacks. ... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... An acute infectious disease caused by spirochetes of the genus Borrelia, relapsing fever (also called tick, fowl-nest, cabin, or vagabond fever or bilious typhoid) is transmitted to humans by lice or ticks and is characterized by relapses... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Acute rheumatic fever is a systemic inflammatory disease of childhood, in many cases recurrent, that follows a group A beta-hemolytic streptococcal infection. Rheumatic heart disease refers to the cardiac manifestations of rheumatic fever and includes pancarditis ... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. Croup syndrome is most common in boys and most... Emergency interventions ... History and physical examination ... Medical causes ... Special considerations
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... Productive coughing is the body’s mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn’t remove. It’s a sudden, forceful, noisy expulsion of air (from the lungs) that contains sputum or blood ... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn’t yield sputum or blood. It’s one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective mechanism that clears airway... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Fever is a common sign that can arise from numerous disorders. Because these disorders can affect virtually any body system, fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though, represents an... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Désirée A. Lie
Cough is among the top 10 reasons for visits to family physicians in the United States. It accounts for 200 to 400 million episodes of illness per year. Three causal conditions increasing in frequency over the... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Lyle J. Fagnan
Fever is a physiologic state in which the body temperature is elevated above the individual’s normal temperature. Patients and clinicians consider fever an important sign of illness.
Approach to the febrile ... History ... Physical examination ... Testing. ... Diagnostic assessment. ... Pictures
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... Michael L. O’Dell
Fever with an accompanying rash represents a diagnostic challenge for even the most experienced of clinicians, as this combination of signs can represent trivial or life-threatening illnesses. ... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Differential Overview
❑ Rhinovirus
❑ Group A streptococci
❑ Ebstein-Barr virus
❑ Adenovirus ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
Infection
❑ HIV
❑ Tuberculosis
❑ Endocarditis
❑ Osteomyelitis
❑ Malaria ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Viral upper respiratory infection
❑ Asthma
❑ Sinusitis
❑ Mycoplasma bronchitis
❑ Pneumonia ... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Upper respiratory infection
❑ Allergy
❑ Asthma
❑ Chronic bronchitis
❑ Chronic sinusitis ... Diagnostic Approach ... Clinical Findings ... Pictures
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... In patients with essentially normal lung tissue, acute respiratory failure (ARF) usually means a partial pressure of arterial carbon dioxide (Paco2) greater than 50 mm Hg and a partial pressure of arterial oxygen (Pao2) less than 50 mm Hg. These limits,... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... An acid-base disturbance characterized by reduced alveolar ventilation and manifested by hypercapnia (partial pressure of arterial carbon dioxide [Paco2] greater than 45 mm Hg), respiratory acidosis can be acute (from a sudden failure in... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Caused by alveolar hyperventilation, respiratory alkalosis is a condition marked by a decrease in partial pressure of arterial carbon dioxide (Paco2) to below 35 mm Hg. Uncomplicated respiratory alkalosis leads to a decrease in hydrogen ion concentration, which... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Also called hyaline membrane disease and infant respiratory distress syndrome, respiratory distress syndrome is the most common cause of neonatal mortality.
Respiratory distress syndrome affects 10% of... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... A subgroup of the myxoviruses resembling paramyxovirus causes respiratory syncytial virus (RSV) infection. RSV is the leading cause of lower respiratory tract infections in infants and young children; it’s the major cause of pneumonia, tracheobronchitis, and bronchiolitis in... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... A lung abscess is an infection accompanied by pus accumulation and tissue destruction. The abscess may be putrid (due to anaerobic bacteria) or nonputrid (due to anaerobes or aerobes), and it commonly has a well-defined border. The availability of effective... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Lung cancer usually develops within the wall or epithelium of the bronchial tree. Its most common types are epidermoid (squamous cell) carcinoma, small cell (oat cell) carcinoma, adenocarcinoma, and large cell (anaplastic) carcinoma. ... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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... Often recurrent, acute rheumatic fever is a systemic inflammatory disease of childhood that follows a group A beta-hemolytic streptococcal infection. Rheumatic heart disease refers to the cardiac manifestations of rheumatic fever,... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. Croup syndrome is most common in boys.... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Nursing considerations ... Patient teaching
... READ EXCERPTS »
... Productive coughing is the body’s mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn’t remove. It’s a sudden, forceful, noisy expulsion of air (from the lungs) that contains sputum, blood, or both. The sputum’s... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Fever is a common sign that can arise from any one of several disorders. Because these disorders can affect virtually any body system, fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though,... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. Croup syndrome is most common in boys and most prevalent in the fall; it... History ... Physical assessment ... Medical causes ... Special considerations ... Patient counseling ... Pictures
... READ EXCERPTS »
... Productive coughing is the body’s mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn’t remove. It’s a sudden, forceful, noisy expulsion of air (from the lungs) that contains... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Fever, or pyrexia, is a common sign that can arise from any one of several disorders. Because these disorders can affect virtually any body system, fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though, represents... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn’t yield sputum. It’s one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective mechanism that clears airway... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Definedas sound that occurs on sudden release of air under high pressure,which is generated by forceful contraction of expiratory musclesagainst a closed glottis. Clinical dilemma is to determine whethercoughing is associated with mild illness or more... Principal Causes of Cough ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Occurs whenpathologic process causes body temperature to exceed normal range. DuBois suggested that usual range ofnormal body temperature is 97–100.4°F (36.2–38.0°C)rectal or 96.8–99.3°F (36.0–37.4°C)oral. Rectal temperature tends to be 0.5–1.0... Principal Causes of Acute Fever ... Clinical Features and Diagnosis: Acute Fever ... Diagnostic Approach: Acute Fever ... Principal Causes of Fever of Unknown Origin ... Clinical Features and Diagnosis: Fever of Unknown Origin ... Diagnostic Approach: Fever of Unknown Origin ... References
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...Sore throat refers to any painful sensationof the pharynx or surrounding tissues and is a common complaintin childhood and adolescence. Principal Causes of Sore Throat Infection Pharyngitis/tonsillitis Viral Bacterial Group ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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...Signs of respiratory distress include tachypnea,dyspnea, nasal flaring, grunting, retractions, and cyanosis. Apneais an extreme form of respiratory distress. Respiratory distress(neonatal and postneonatal) is discussed in the first part of thechapter and... Principal Causes of Respiratory Distress (Neonatal) ... Clinical Features and Diagnosis: Respiratory Distress (Neonatal) ... Principal Causes of Respiratory Distress (Postneonatal) ... Clinical Features and Diagnosis: Respiratory Distress (Postneonatal) ... Diagnostic Approach: Respiratory Distress ... Principal Causes of Apnea ... Clinical Features and Diagnosis: Apnea ... Diagnostic Approach: Apnea ... References
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... Stertoris noisy, snoring-type breathing that results from airway obstructionin the nose, nasopharynx, or oropharynx. The sounds are heard onlyduring inspiration. Stridor is a low- to medium-pitchedsound that signifies airway obstruction in the supraglottic, glottic,... Principal Causes of Airway Obstruction ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Resonant, brassy, and harsh, a barking cough is part of a complex of signs and symptoms that characterize croup syndrome, a group of pediatric disorders marked by varying degrees of respiratory distress. It's most prevalent in the fall and may recur in the... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... Productive coughing is the body's mechanism for clearing airway passages of accumulated secretions that normal mucociliary action doesn't remove. It's a sudden, forceful, noisy expulsion of air from the lungs that contains sputum, blood, or both. The sputum's color,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... A nonproductive cough is a noisy, forceful expulsion of air from the lungs that doesn't yield sputum or blood. It's one of the most common complaints of patients with respiratory disorders.
Coughing is a necessary protective mechanism... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
... READ EXCERPTS »
... A fever is a common sign that can arise from many disorders. Because these disorders can affect virtually any body system, a fever in the absence of other signs usually has little diagnostic significance. A persistent high fever, though, represents an emergency. ... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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...
The differential diagnosis of cough is best developed with the use of
anatomy. Cough may arise from an irritative focus anywhere along the
respiratory tract. The irritation may be intrinsic, in which case it
is usually inflammatory, neoplastic, or... Pictures
... READ EXCERPTS »
...
The differential diagnosis of fever is best developed using
physiology first and anatomy second.
Physiology. Increased heat in the body is caused by increased
production or decreased elimination or dysfunction of the... Pictures
... READ EXCERPTS »
...
Breaking down the oropharynx, nasopharynx, and larynx into anatomic
components is not very valuable in developing a differential diagnosis of
sore throat. What is useful is to use the mnemonic VINDICATE to
establish the... Pictures
... READ EXCERPTS »
Allergies can leave children feeling sniffly, teary and itchy and take their toll at play and at school. Previously, allergy remedies left children...
When you have watery eyes, a runny nose, congestion and sneezing, how can you tell if it's a cold or an allergy? Find out the difference and the...
"I authorize the release of any medical or other information necessary to process this claim." Do you recognize these words? You should, if...
Stress takes its toll by making us anxious, depressed and not able to function as fully as we'd like. What many don't know is that stress can...